Nezu T, et al. - The present study was planned to investigate the associations between plasma D-dimer levels at admission, clinical characteristics and mortality at discharge in cryptogenic stroke patients. In addition, researchers assessed if D-dimer levels could predict long-term outcomes in those patients, including those with and without right-to-left shunt (RLS). In cryptogenic stroke patients, an association of increased D-dimer levels at admission with mortality at discharge was observed. High D-dimer levels were also found to have a correlation with long-term outcomes in cryptogenic stroke patients with RLS.

Methods

• Researchers consecutively enrolled and retrospectively analyzed acute cryptogenic stroke patients (n = 295, 72 ± 13 years old).
• The cryptogenic stroke was defined as an undetermined etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria.
• Evaluation of plasma D-dimer levels at admission was performed.
• Using saline contrast-transcranial Doppler ultrasonography or contrast-transesophageal echography, they performed assessments for RLS.
• Follow-up for up to 3 years after stroke onset was performed of the survivors (at discharge).

Results

• Seventeen patients of the total enrolled cohort died at discharge.
• With initial National Institutes of Health Stroke Scale (NIHSS) score, D-dimer levels were correlated (r = 0.391, P < 0.001); these levels were associated with mortality at discharge [odds ratio 1.04; 95% confidence interval (CI) 1.00–1.08, P = 0.049] after adjusting for age, sex and initial NIHSS score.
• Researchers evaluated 266 patients to assess RLS during hospitalization among the 278 survivors at discharge; 62 patients (23.3%) exhibited RLS.
• The patients were divided into a low D-dimer group (n = 136, < median) and a high D-dimer group (n = 130, ≥ median) in accordance to the median plasma D-dimer levels at admission (0.7 μg/ml).
• Compared to the patients in the low D-dimer group, patients in the high D-dimer group were older, more frequently female, had a lower BMI, had a higher prevalence of cancer and had greater initial neurological severity.
• Recurrent stroke developed in 31 patients and death of 33 patients was reported during the follow-up period (median, 1,093 days).
• An independent association of high D-dimer levels at admission was observed with recurrent stroke and all-cause mortality [hazard ratio (HR) 3.76; 95% CI 1.21–14.1, P = 0.021) in patients with RLS, but not in those without RLS (HR 1.35; 95% CI 0.74–2.50, P = 0.335).